Children's Oncology Group's 2023 blueprint for research: Diversity and health disparities

Abstract

The Children's Oncology Group (COG) Diversity and Health Disparities Committee's (DHDC's) mission is to guarantee the highest standard of care for children and adolescents and young adults (AYA) with cancer regardless of ethnic, racial, gender, or socioeconomic background. We strive to identify and address issues of disparity within the existing scientific structure of COG and to support research across COG to improve survival by ensuring equitable access to COG-sponsored clinical trials. We are committed to advance COG-led research identifying mechanistic drivers of disparities and, concurrently, evaluating interventions to alleviate disparities in the COG trial setting. As trials identify the most promising therapies, diverse representation is critical to ensure that findings are relevant to everyone. Factors impacting clinical trial participation among vulnerable populations are complex, consisting of barriers at societal, systems, and individual levels. Recent efforts by investigators within DHDC demonstrated that trial-embedded collection of family-reported sociodemographic data and social determinants of health (SDoH) is feasible and acceptable in the context of COG. Diversity in the pediatric oncology workforce is essential and one potential approach to improving representation on clinical trials. To support and retain diverse oncology providers and researchers, a Minority Young Investigator Award (MYIA) was created to facilitate opportunities for graduating trainees and YIs with an interest in childhood cancer disparities research within COG. Although there are challenges to achieve the DHDC's priorities, only through collaboration and support for this work we will be able to elucidate mechanisms underlying inferior survival outcomes for historically marginalized children and AYA, and more importantly, implement interventional investigation to improve outcomes.

Keywords: general; oncology; pediatric oncology.

Figure 1:

Total COG Enrollments 2016 – 2022 by Race and Ethnicity in the US Figure 1 shows overall enrollment of patients by race and ethnicity on COG studies over the last seven years (ranging from ~11,000–15,000 per year including ~7,000 patients enrolled on the registry study, Project Every Child) in the US. During this period, the percentage of minoritized patients enrolled is trending up from 31.6% in 2016 to 36.1% in 2022.

Figure 2:

DHDC Accomplishments, Related Key Priority Goals and Strategies for Next Steps

Figure 3:

COG’s Diversity and Health Disparities Committee Structure

Figure 4:

Approach to identifying and addressing health equity targets in pediatric oncology